Individual
MARQUEE JO SHINER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1911 MAIN ST, SALMON, ID 83467-4512
(208) 303-6616
Mailing address
PO BOX 23, LEMHI, ID 83465-0023
(208) 303-6616
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-3579
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MAS-3579
ALL INSURANCES
ID
05
—
MAS-3579
—
ID
Enumeration date
09/01/2020
Last updated
09/01/2020
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